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Title: Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery

Author
item CHANG, CINDY - University Of Washington
item TREHAN, INDI - University Of Malawi
item WANG, RICHARD - University Of Washington
item THAKWALAKWA, CHRISSIE - University Of Malawi
item MALETA, KEN - University Of Malawi
item DEITCHLER, MEGAN - Fhi 360
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/23/2012
Publication Date: 2/1/2013
Citation: Chang, C.Y., Trehan, I., Wang, R.J., Thakwalakwa, C., Maleta, K., Deitchler, M., Manary, M.J. 2013. Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery. Journal of Nutrition. 143(2):215-220.

Interpretive Summary: Moderate acute malnutrition affects 11% of children under 5 years old worldwide and increases their risk for morbidity and mortality. We analyzed the growth, mortality, and relapse of children who had been successfully treated for moderate malnutrition with blended flours or peanut paste products. A total of 1967 children were enrolled in the study, having successfully recovered from moderate malnutrition; those treated with the soy/whey peanut paste were more likely to remain well-nourished (67%) than those treated with corn soy blend (62%) or soy/peanut paste (59%). Evidence from this study demonstrates that children successfully treated for moderate malnutrition with soy/whey peanut paste are more likely to remain well-nourished; however, all children having recovered from moderate malnutrition remain at risk for relapse or other poor outcomes.

Technical Abstract: Moderate acute malnutrition (MAM) affects 11% of children <5 y old worldwide and increases their risk for morbidity and mortality. It is assumed that successful treatment of MAM reduces these risks. A total of 1967 children aged 6-59 mo successfully treated for MAM in rural Malawi following randomized treatment with corn-soy blend plus milk and oil (CSB++), soy ready-to-use supplementary food (RUSF), or soy/whey RUSF, were followed for 12 mo. The initial supplementary food was given until the child reached a weight-for-height Z-score (WHZ) >-2. The median duration of feeding was 2 wk, with a maximum of 12 wk. The hypothesis tested was that children treated with either RUSF would be more likely to remain well-nourished than those treated with CSB++. The primary outcome, remaining well-nourished, was defined as mid-upper arm circumference >/= 12.5 cm or WHZ >/= -2 for the entire duration of follow-up. During the 12-mo follow-up period, only 1230 (63%) children remained well-nourished, 334 (17%) relapsed to MAM, 190 (10%) developed severe acute malnutrition, 74 (4%) died, and 139 (7%) were lost to follow-up. Children who were treated with soy/whey RUSF were more likely to remain well-nourished (67%) than those treated with CSB++ (62%) or soy RUSF (59%) (P = 0.01). A seasonal pattern of food insecurity and adverse clinical outcomes was observed. This study demonstrates that children successfully treated for MAM with soy/whey RUSF are more likely to remain well-nourished; however, all children successfully treated for MAM remain vulnerable.